The traditional method of abdominal surgery involves creating an incision in a patient large enough so that the surgeon can work with and handle directly the patient's organs and tissues. Unfortunately, this traditional method carries with it a relatively high risk of infection due to the exceptional amount of exposure to which the patient's internal organs are subjected during the surgery. Other significant drawbacks associated with traditional methods of abdominal surgery are the length of recovery time required for a patient and the significant pain suffered because of the size of the incision.
These negative effects of surgical treatment were significantly mitigated by the introduction of endoscopic surgery. Endoscopic surgery generally involves making one or more relatively small incisions in a patient's abdomen and then inserting one or more small surgical tools. The surgical tools are generally mounted on one end of a long, thin element having on the other end a handle and a means for actuating or manipulating the surgical tool. The endoscopic surgical tools are also often outfitted with optical and light-delivery channels so that the surgeon can view the area of the surgery.
While the advent of endoscopic surgical techniques significantly reduced the drawbacks of traditional surgical techniques, endoscopic surgery still involves a relatively high risk of infection, a relatively long recovery period, and significant pain for the patient. Recently, these negative effects have been even further reduced by the introduction of transgastric and transluminal endoscopic surgery.
In transgastric surgery, for example, an endoscopic tool is inserted into the patient's mouth and fed to the patient's stomach. The wall of the patient's stomach can then be punctured so that the tool can access other parts of the patient's abdomen. An incision in the wall of the stomach is preferable to external incisions because there are no nerve endings in the stomach. Transgastric endoscopic surgery reduces patient pain and recovery time as well as the risk of infection.
The endoscopic tool that is inserted into the patient for transgastric or transluminal surgery generally includes one or more surgical tools, an optical channel, one or more light channels, and/or one or more channels for evacuation or insufflation. The tools preferably have other unique features. First, they preferably are designed such that insertion into the patient's body is easy and causes the patient a minimum of trauma. Second, the tool preferably provides a means for multiple surgical tools to be used to exert force or perform functions in multiple directions at the surgical site. This is more difficult in transgastric and transluminal surgery because there is only one possible angle of approach since the tools are preferably inserted in the same place, for example, the patient's mouth. In conventional endoscopic surgery on the other hand, tools can be inserted at multiple locations so that the surgeon has an advantageous ‘working triangle.’ The working triangle allows the surgeon to exert force in multiple directions and therefore better perform surgical tasks. In transgastric and transluminal surgery, it is more difficult to create this working triangle since the tools are inserted parallel to one another.
There are various examples in the prior art of endoscopic tools which are intended for or could be used in transgastric or transluminal surgery and which attempt to address the foregoing concerns. For example, U.S. Pat. No. 6,066,090 to Yoon, U.S. Pat. No. 6,352,503 to Matsui et al., and U.S. Pat. No. 7,029,435 to Nakao all disclose endoscopic surgical apparatuses.
Yoon discloses an endoscope with two or more flexible branches, which are independently steerable, and include a source of illumination, a means for viewing the surgical site, and an operating channel through which surgical instruments may be passed. The two branches may be used to approach a surgical site from two angles so that the surgeon has two distinct views of the site and two angles in which force can be exerted.
The device disclosed by Yoon, however, suffers from significant drawbacks. Among the most notable of these is the fact that each branch of the endoscope must be separately steered and manipulated in order to obtain the proper positioning of the system at the surgical site. This increases the difficulty and hence duration of a surgery.
Matsui et al. discloses an endoscope and two treating tools which are inserted into a body cavity of a patient. The distance between the treating tools is adjusted by a distance adjusting device such as a balloon or an expandable basket.
The apparatus disclosed by Matsui et al. has significant drawbacks, however. Most significant of these drawbacks is its complexity. As shown in FIGS. 1 and 7 it contemplates insertion of an outer tube unit for guiding at least the insertion of an endoscope, two “treating tool leading insertion tools,” and two treating tools. The method of creating distance between the treating tools, either by means of a balloon or expandable basket, further increases the complexity of the system because the distance adjusting device requires manual engagement.
Nakao discloses a flexible fiber optic endoscope which is split longitudinally on its distal end into working segments. The split allows a plurality of working elements which extend through working channels of the working segments to be separated from one another and independently maneuvered. During insertion, a sheath is used to temporarily join the working segments.
While the design of Nakao appears to provide a relatively simple solution to the above-described problems, it also has notable limitations. First, operation of the system is unduly complex as a result of the various components which must be manipulated in order to begin surgery. The sheath must be moved in order to allow the segments to separate. Each working segment must be positioned, the visualization segment must be positioned, and then the surgical tools must be manipulated. This is a complex process that would most likely require many individuals. Second, while the longitudinal split may allow for suitable separation of the working segments and thus the working elements, it is unclear from the figures or the description that there is adequate provision for redirecting the working elements back toward the longitudinal axis where the surgical site is located to form the working triangle.
Therefore, what is needed is an endoscopic surgery apparatus that has a thin profile so that it is easy to insert into the patient and that provides the surgeon with the ability to exert force in multiple directions at the surgical site.